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Application Form - A-level center (15-18 years old)
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Additional Information
Academic History | 就学经历

(Most Recent First 从最近求学的学校开始)

Previous Schools

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Asperger’s Syndrome | 阿斯伯格综合征
Attention Deficit Hyperactivity Disorder | 注意力不足过动症
Autism | 孤独症
Dyslexia | 阅读障碍症
Dyspraxia | 运用障碍
Depression | 抑郁症
Eating Disorder | 厌食症
Emotional/Behavioural Delay/Disorders | 情绪/行为发育迟缓症
Language and Speech Delay/Disorders | 语言发育迟缓症
Learning Disabilities | 学习障碍
Any other condition which we should be aware of | 其他您认为校方应该了解的孩子情况

Medical Information | 医疗信息

Please select Yes if your child has (or has had in the past) any of the following conditions and provide additional information on such condition (or any other condition if not listed).
如果您的孩子具有(或者曾经有)下述状况,请在表格内标示 “Yes”,并向校方提供孩子的详细情况说明 (如您的孩子的情况并未出现在下列表格中,请务必向学校说明。)

Health Information
Immunization Record

Has your child received the following vaccinations? 您的孩子是否曾接种过下列疫苗?

Measles Mumps Rubella (MMR) | 麻疹腮腺炎风疹

Date of Vaccination | 接种疫苗日期

Diphtheria Pertussis Tetanus (DPT) | 百日咳白喉破伤风

Date of Vaccination | 接种疫苗日期

Hepatitis B (HepB) | B型肝炎

Date of Vaccination | 接种疫苗日期

Hepatitis A (HepA) | A型肝炎

Date of Vaccination | 接种疫苗日期

Tuberculosis (B.C.G.) | 肺结核

Date of Vaccination | 接种疫苗日期

Haemophilus Influenzae Type B (Hib) | B型流感嗜血杆菌

Date of Vaccination | 接种疫苗日期

Chicken Pox | 水痘

Date of Vaccination | 接种疫苗日期

Rabies | 狂犬病

Date of Vaccination | 接种疫苗日期

Annual Flu Vaccine | 年度流感疫苗

Date of Vaccination | 接种疫苗日期

If your child has medical insurance, please provide details. 如果您的孩子已经办理了医疗保险,请提供相关信息。

Note: Medical and Liability: The Parents are responsible for the medical insurance/insurance of Pupils while attending the College and must make provision before attending the College. Unless negligent or guilty of some wrongdoing causing injury, loss or damage, the College does not accept responsibility for accidental injury or other loss caused to the Pupil or the Parents/Guardian or for the loss or damage to property.

备注:医疗责任:学生在本校就读期间,学生家长自行负责学生的医疗保险/保险事宜,且需在就读本校前作出完成相关事宜。除因疏忽或错误行为造成的伤害、损失或损害,本校对于意外伤害或其他损失的责任造成学生或家长/监护人的损失或财产损失不承担任何责任。

Person(s) to Notify in an Emergency

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Emergency Medical Treatment: It is the Parents/Guardians responsibility to make adequate provision for medical insurance during the pupil’s enrolment at the College.

紧急医药处置方案:学生在本校就读期间,家长/监护人有责任为该学生选择适合的医疗保险。